| NPI | 1801889399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR MD28514) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD28514) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OR MD28514) | |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2021-06-07 |