| NPI | 1598783227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MO 2004011774) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: MO 2004011774) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2024-04-25 |