| NPI | 1033614649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: SC 89548) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT216020) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2023-06-29 |