| NPI | 1790724466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: AZ 20404) |
| Additional Taxonomies | 207RS0010X Internal Medicine Sports Medicine (Licence: LA MD207481) |
| 207X00000X Orthopaedic Surgery (Licence: RI 8363) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2019-01-11 |