| NPI | 1528388584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: AZ 56027) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ 56027) |
| 207X00000X Orthopaedic Surgery (Licence: OR MD177814) | |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2022-07-25 |