| NPI | 1609843481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: GA 48075) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: AL 18564) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2019-12-06 |