| NPI | 1861667982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME115536) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 233111) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2013-12-02 |