| NPI | 1588793533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NV DO2241) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 020702009) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2018-09-13 |