| NPI | 1396182945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MD D0087173) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI MD16282) |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2019-08-14 |