| NPI | 1306376801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MO 2023024920) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2023024920) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TN 65167) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-08-04 |