| NPI | 1902021041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 053861) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 053861) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2013-02-06 |