| NPI | 1912338112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MT205356) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: DE C7-0005493) |
| Enumeration Date | 2013-12-13 |
| Last Update Date | 2013-12-13 |