| NPI | 1760592448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 42702) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: WI 42702) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-02-25 |