| NPI | 1275923971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 11709309-1205) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 70082) |
| 207X00000X Orthopaedic Surgery (Licence: MN 70082) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: UT 11709309-1205) | |
| Enumeration Date | 2015-02-02 |
| Last Update Date | 2021-12-15 |