| NPI | 1538507520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: ID O-1367) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101020674) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 63489) | |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2024-03-07 |