| NPI | 1750490512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MS 12255) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MS 12255) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |