| NPI | 1083600225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR DO27136) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OS010171-L) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: GA 054671) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2025-03-14 |