| NPI | 1073612842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 9600117) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 9600117) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2025-02-19 |