| NPI | 1942649405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME141436) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301103204) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IL 036145003) | |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2022-05-26 |