| NPI | 1730443961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2019045626) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 56709) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 56709) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2020-02-12 |