| NPI | 1538555487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 2021-01616) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 209723) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2021-06-05 |