| NPI | 1447503354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 6045) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 6045) |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2023-02-14 |