| NPI | 1124037650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID M16347) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: ID M16347) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2025-10-28 |