| NPI | 1003886334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO CO40753) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0040753) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2025-02-27 |