| NPI | 1790703338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: ND 9386) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 46450) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-03-07 |