| NPI | 1760640734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 076634) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SC 30755) |
| 207X00000X Orthopaedic Surgery (Licence: ME MD26095) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CT 052544) | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2023-03-08 |