| NPI | 1467488163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: LA MD.14786R) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA MD.14786R) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2015-12-01 |