| NPI | 1508870619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 5883) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: SD 5883) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2008-07-11 |