| NPI | 1972640092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MD P21476) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO 49711) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2017-05-22 |