| NPI | 1497169007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IA MD-47679) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 202526) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO 62782) | |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2020-08-24 |