NPI | 1356326870 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD60464124) |
Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 204678) |
Enumeration Date | 2005-12-07 |
Last Update Date | 2018-05-03 |