| NPI | 1790999415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35.120264) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.120264) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: OH 35.120264) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME108709) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2021-01-28 |