| NPI | 1710367719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 12693) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 94-08611) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WI 73163) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2022-01-27 |