| NPI | 1699944017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME117956) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 241021) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MD D0072488) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AL 30131) | |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2022-02-28 |