| NPI | 1396752770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 2003-01234) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101250123) |
| 207X00000X Orthopaedic Surgery (Licence: KY 26510) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101250123) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2021-04-23 |