| NPI | 1386105575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 99978) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: GA 99978) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: GA 99978) | |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2026-07-29 |