| NPI | 1578189304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0074810) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2020014718) |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2025-07-23 |