| NPI | 1376836254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 2017-01588) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TN 56416) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2024-03-12 |