| NPI | 1528015591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS 005621 L) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: OH 34 00 5210) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2021-01-08 |