| NPI | 1366890402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IA R-12305) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WI 77420) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2023-02-23 |