| NPI | 1427511005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX W0144) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA 340169) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX W0144) | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2025-08-18 |