| NPI | 1396954749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AL MD.27183) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2009-00524) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 2009-00524) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AL MD.27183) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2010-10-26 |