| NPI | 1508084005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: LA MD-202539) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101241612) |
| 207X00000X Orthopaedic Surgery (Licence: MS 24514) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME114694) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MS 24514) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2021-02-16 |