| NPI | 1568624542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR MD170616) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: OR MD170616) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2021-05-17 |