| NPI | 1366888596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2020-00445) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2020-00445) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: NC 2020-00445) | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2021-03-31 |