| NPI | 1851446934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MD D0081136) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CA A98276) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2022-02-14 |