| NPI | 1336116367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NE 19572) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IA 30699) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2016-07-25 |