| NPI | 1922171958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101243516) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD072496L) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2017-12-05 |