| NPI | 1760771794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: UT 8438015-1205) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CT 55564) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MA 270960) | |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2018-09-25 |