| NPI | 1558748871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MO 2022039230) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AL MD.40953) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2023-03-21 |