| NPI | 1053755454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TX P9133) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX P9133) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2025-08-26 |