| NPI | 1457701492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA OS021880) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT016891) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA OS021880) | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2022-09-01 |