| NPI | 1639193626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AL MD.41721) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VT 42-0010895) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: VT 42-0010895) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2021-03-03 |