NPI | 1366890402 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IA R-12305) |
Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WI 77420) |
Enumeration Date | 2016-05-31 |
Last Update Date | 2023-02-23 |