| NPI | 1649303850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MA 242059) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 045412) |
| 207X00000X Orthopaedic Surgery (Licence: MA 242059) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-12-21 |