| NPI | 1376645580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: SC 457) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MI MS007501) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2011-10-24 |