| NPI | 1922027507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX G5160) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX G5160) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX G5160) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-03-07 |