| NPI | 1669603239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IL 125.055782) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35.123211) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 46938) | |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2014-05-23 |