| NPI | 1659725018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: OH 35.133115) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.133115) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2025-03-13 |