| NPI | 1396186920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MA 279055) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 58197) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2019-08-08 |