| NPI | 1679790554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: LA MD.205620) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI LP01011) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IL 036127990) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2016-12-12 |