| NPI | 1720255326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NC 2011-01076) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2011-01076) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2018-03-28 |