| NPI | 1871913756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OR MD198108) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IA R-10015) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: UT 11265667-1205) | |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2023-01-11 |