NPI | 1619325644 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: SC 92685) |
Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 102207321) |
Enumeration Date | 2016-05-31 |
Last Update Date | 2024-12-31 |