| NPI | 1487652681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 38895) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NC 9600298) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2020-10-22 |