| NPI | 1649392549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WI 51923-20) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AL MD.28068) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2019-12-13 |