| NPI | 1639162225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME163665) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO R9F75) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2025-05-01 |