| NPI | 1356474597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 40756) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: KY 40756) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2022-11-30 |