| NPI | 1467973131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: UT 12792783-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 64400) |
| 207X00000X Orthopaedic Surgery (Licence: MN 28640) | |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2023-05-11 |