| NPI | 1730396904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: SD 10419) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101252248) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: KY 49155) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2019-10-31 |