| NPI | 1790710093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: SC 12856) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: SC 12856) |
| 207X00000X Orthopaedic Surgery (Licence: SC 12856) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2022-02-21 |