| NPI | 1477725455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 82519) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AL MD.33550) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 46371) | |
| Enumeration Date | 2008-03-30 |
| Last Update Date | 2020-03-30 |