| NPI | 1518377431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AR E-13148) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM MD2019-0585) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MO 2020029147) | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2021-02-04 |