| NPI | 1669922969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2022-01292) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: SC 85638) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2025-12-26 |