| NPI | 1902805575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME87792) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME9748) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: GA 55351) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2023-04-26 |