| NPI | 1679587232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: SC 17469) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SC 17469) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: SC 17469) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2023-04-27 |