| NPI | 1952313181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX K8066) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TX K8066) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2021-05-25 |