| NPI | 1194258277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA OS023838) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA 05023838) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2025-08-11 |