| NPI | 1750817573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35.148364) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PR 33974) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-10-17 |