| NPI | 1982601530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 033613) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: CT 033613) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CT 33613) | |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2019-03-11 |