| NPI | 1730154634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301067934) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD073247L) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MI 4301067934) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2016-01-28 |