| 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 |