| NPI | 1760480222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: DC MD33380) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MD D0064915) |
| 207X00000X Orthopaedic Surgery (Licence: DC MD33380) | |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2019-01-08 |