| NPI | 1336675016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: UT 1336810-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: UT 13363810-1205) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2025-03-03 |