| NPI | 1598183196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301501710) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2019-00572) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MI 4301501710) | |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2021-03-10 |