| NPI | 1780676114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO 36899) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO 36899) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2012-05-31 |