| NPI | 1740627736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX r6605) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MS 25336) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2020-08-11 |