| NPI | 1750724167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2023-02667) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: GA 92602) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 2023-02667) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0102205681) | |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2024-05-17 |