| NPI | 1588639256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: WI 54584) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: PA OS010647L) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2020-03-25 |