| NPI | 1073000477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX V7040) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX V7040) |
| 207X00000X Orthopaedic Surgery (Licence: GA 90636) | |
| 207X00000X Orthopaedic Surgery (Licence: PA OT018783) | |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2026-03-19 |