| NPI | 1659612240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NE 28078) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 28078) |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2023-10-20 |