| NPI | 1679565758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO CDR.0002201) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: UT 51866291205) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2023-07-03 |