| NPI | 1083067656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MD H0106815) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0102208939) |
| 207X00000X Orthopaedic Surgery (Licence: GA 79286) | |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2026-08-03 |