| NPI | 1285293902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 13869928-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 279562) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: UT 13869928-1205) | |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2024-04-25 |