| NPI | 1497259345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 58994) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2023015205) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 58994) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2024-07-10 |