| NPI | 1891766978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: GA 027815) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: SC MD19666) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2021-02-08 |