| NPI | 1629028410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AZ 51325) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IA 27628) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WI 29782) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2016-11-03 |