| NPI | 1295151520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: ZZ 1) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ZZ 2) |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2014-03-11 |