| NPI | 1326222514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ND 12363) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MI 4301098134) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2021-08-03 |