| NPI | 1366803843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA OS022100) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OS022100) |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2022-07-15 |