| NPI | 1467712174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX S1015) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10043388) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2022-09-01 |