| NPI | 1669673869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: IA 39263) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.089019) |
| 207X00000X Orthopaedic Surgery (Licence: SC 32393) | |
| 207X00000X Orthopaedic Surgery (Licence: IA 39263) | |
| 207X00000X Orthopaedic Surgery (Licence: IL 036126735) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: IL 036126735) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: IA 29263) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2016-01-15 |