| NPI | 1689028417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MO 2022012833) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2022012833) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2026-01-13 |