| NPI | 1740845395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 58.031132) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT019712) |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2025-07-01 |