| NPI | 1417376120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0062553) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA 00000000) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO 62553) | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2022-05-13 |