| NPI | 1891910790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 2018-02328) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2018-02328) |
| 207X00000X Orthopaedic Surgery (Licence: VA 010125194) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-11-11 |