NPI | 1982015236 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD471151) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD UMPS) |
Enumeration Date | 2014-05-08 |
Last Update Date | 2022-11-10 |