| NPI | 1841232691 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: GA 57695)  | 
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AL MD.28249)  | 
| 207X00000X Orthopaedic Surgery (Licence: GA 057695)  | |
| Enumeration Date | 2006-06-12 | 
| Last Update Date | 2020-11-19 |