| NPI | 1982645636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WY 8467A) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NE 452) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2012-04-02 |