| NPI | 1700828555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 055733) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OR MD211513) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: GA 055733) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2022-07-19 |