| NPI | 1790706430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 10506) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA C143100) |
| 207X00000X Orthopaedic Surgery (Licence: TX S0422) | |
| 207X00000X Orthopaedic Surgery (Licence: PA MD450150) | |
| 207X00000X Orthopaedic Surgery (Licence: OR MD26880) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OR MD26880) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2020-09-24 |