| NPI | 1891728457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TN MD41381) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 620988417) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2012-11-07 |