| NPI | 1487828430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101255787) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MD D0077540) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A124057) | |
| Enumeration Date | 2008-04-19 |
| Last Update Date | 2014-11-06 |