| NPI | 1790808848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TN 3817) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NC 2014-00194) |
| 207X00000X Orthopaedic Surgery (Licence: NC 2014-00194) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2020-09-10 |