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 |