| NPI | 1811942592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 59217) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MS 19268) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: GA 059217) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2023-01-24 |