| NPI | 1609499136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0074901) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SC 84228) |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2025-08-01 |