| NPI | 1619064730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TN MD37885) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TN MD37885) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY KY38163) | |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2022-03-25 |