| NPI | 1225491368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MD D0093628) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101275551) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2026-05-21 |