| NPI | 1700868577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2005-00440) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 2005-00440) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2018-07-17 |