| NPI | 1861886491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: LA 328867) |
| Additional Taxonomies | 273Y00000X Rehabilitation Unit |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2021-10-06 |