| NPI | 1568631919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AZ 48053) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ 48053) |
| 207X00000X Orthopaedic Surgery (Licence: CA A107229) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO 51323) | |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2022-10-18 |