| NPI | 1558677690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX R0125) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 249831-1) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: ND PT 12022) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A112987) | |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2020-02-07 |