| NPI | 1629064449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery |
| 207XX0005X Orthopaedic Surgery Sports Medicine | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2008-03-04 |