| NPI | 1295787323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 47720621205) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: UT 4772062-1205) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2021-10-16 |