| NPI | 1407887797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MS 14854) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MS 14854) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2019-04-10 |