| NPI | 1659698298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0059216) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM MD2015-0287) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IL 036140589) | |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2022-07-21 |