| NPI | 1720030190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MO 2009024744) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2009024744) |
| 207X00000X Orthopaedic Surgery (Licence: AL 19898) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2022-09-12 |