| NPI | 1396907762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME116858) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: DC unlicensed resident) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A119887) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2013-10-25 |