| NPI | 1437165636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 35091) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 15307) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NE 15307) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2012-08-27 |