| NPI | 1629061205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MO 2001007784) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2001007784) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2012-04-19 |