| NPI | 1407007552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME133343) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: GA 64298) |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2022-07-21 |