| NPI | 1306260468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 91809) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101259181) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: SC 91809) | |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2024-08-13 |