| NPI | 1063907939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2018019723) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 323318) |
| Enumeration Date | 2018-06-24 |
| Last Update Date | 2023-07-31 |