| NPI | 1619151719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TN 45071) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME101817) |
| 207X00000X Orthopaedic Surgery (Licence: TN 45071) | |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2009-12-10 |