| NPI | 1912128448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: GA 61038) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 061038) |
| 207X00000X Orthopaedic Surgery (Licence: AL MD.28831) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: AL MD.28831) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2020-11-20 |