| NPI | 1154736817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2014020074) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: GA 85051) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TN 67394) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 296836) | |
| Enumeration Date | 2014-06-21 |
| Last Update Date | 2025-03-20 |