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 |