| NPI | 1881861243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: OH 35.123700) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: FL ME116160) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2023-11-03 |