| NPI | 1932546058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: RI MD16259) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IA R-11467) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2019-05-24 |