| NPI | 1720467707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX T0189) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NV 19891) |
| 207X00000X Orthopaedic Surgery (Licence: CA A168443) | |
| 207X00000X Orthopaedic Surgery (Licence: OK 31487) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CA A168443) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NV 19891) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TX T0189) | |
| Enumeration Date | 2015-05-24 |
| Last Update Date | 2021-07-23 |