| NPI | 1467642629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA OS014282) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS014282) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2020-10-12 |