| NPI | 1598031437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 89173) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301111523) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MS 25843) | |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2021-07-26 |