| NPI | 1821084633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TN 27005) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MS 13114) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2023-01-25 |