| NPI | 1356390611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: LA 12572) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA MD.12572R) |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2013-11-05 |