| NPI | 1750491080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WV 21405) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101271336) |
| 207X00000X Orthopaedic Surgery (Licence: WV 21405) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-05-12 |