| NPI | 1417926718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TX Q3966) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: VA 0101236844) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2018-10-10 |