| NPI | 1740266337 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME98294) | 
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME98294) | 
| Enumeration Date | 2005-12-16 | 
| Last Update Date | 2017-08-09 |