| NPI | 1699303743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD.MD.61682107) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4351046503) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-06-30 |