| NPI | 1700860236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NE 15374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 15374) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NE 15374) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2025-08-25 |