| NPI | 1770801763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: LA 301922) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NM MD2015-0173) |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2021-06-07 |