| NPI | 1710307772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME172329) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA VA0101264557) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2026-07-09 |