| NPI | 1104409606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: ND 22626) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL17358) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2025-08-29 |