| NPI | 1174510622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 18883) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: SC 18883) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2025-01-14 |