| NPI | 1104315118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 92183) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: AL MD.46402) |
| 207X00000X Orthopaedic Surgery (Licence: AL MD.46402) | |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2025-06-02 |