| NPI | 1811371669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OR MD211679) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0064150) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2024-09-18 |