| NPI | 1912173311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 60236) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: WI 60236) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WI 60236) | |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2024-04-25 |