| NPI | 1730189077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: VA 0101056088) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101056088) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2017-06-20 |