| NPI | 1649270059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX E4316) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX E4316) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2023-07-22 |