| NPI | 1124473194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0065919) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX BP10056453) |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2023-10-03 |