| NPI | 1528050929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MN 21557) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MN 21557) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2013-11-15 |