| NPI | 1285614354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MO 2012015106) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO 34174) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: LA DO000117) | |
| 207X00000X Orthopaedic Surgery (Licence: OR DO26461) | |
| 207X00000X Orthopaedic Surgery (Licence: MO 2012015106) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2013-06-10 |