| NPI | 1649471764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 87680) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0102203093) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0102203093) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2023-01-13 |