| NPI | 1760690580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MN 57095) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CO 50769) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2015-07-02 |