| NPI | 1700029196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX N9971) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N9971) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: TX N9971) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2025-04-23 |