| NPI | 1306112743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: SC 88772) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2017021713) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2024-06-17 |