| NPI | 1811945553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO CO30715) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO CO30715) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CO CO30715) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2008-03-13 |