| NPI | 1518047588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WY 6931A) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NE 20195) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: SD 1724) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IA 27005) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2014-01-31 |