| NPI | 1982903183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MT MED-PHYS-LIC-52442) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MT MED-PHYS-LIC-52442) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2019-10-16 |