| NPI | 1225033350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OR MD219220) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX L3745) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2025-11-14 |