| NPI | 1649205741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 40279) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 40279) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2018-11-02 |