| NPI | 1619124906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301102288) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ID M-14818) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: ID M14818) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2025-04-21 |