| NPI | 1851600753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: SC 34578) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD440143) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0101249520) | |
| Enumeration Date | 2010-09-27 |
| Last Update Date | 2022-07-20 |