| NPI | 1487283222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD481251) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: UT 14211854-1205) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2026-09-01 |