| NPI | 1659754059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX S6376) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX BP10053397) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2025-07-31 |