| NPI | 1720142508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0102204066) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SD 7735) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2021-01-19 |