| NPI | 1750810560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 87466) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 94-09179) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: SC 87466) | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2022-11-09 |