| NPI | 1770541690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MA 227553) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: MA 227553) |
| 207X00000X Orthopaedic Surgery (Licence: MA 227553) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2012-12-03 |