| NPI | 1295875581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2007-01087) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101241133) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NC 2007-01087) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2011-09-07 |