| NPI | 1730119090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 8777) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: SC 8777) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-03-11 |