| NPI | 1578769824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MT 35120) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2007-00547) |
| 207X00000X Orthopaedic Surgery (Licence: MT 35120) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2015-01-27 |