| NPI | 1093930562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX N3515) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX N3515) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MI 4301088759) | |
| 207X00000X Orthopaedic Surgery (Licence: MI 4301088759) | |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: TX N3515) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2026-01-21 |