| NPI | 1609139336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME136028) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT201052) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IL 036.142241) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2018-07-30 |