| NPI | 1750901609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: UT 14210215-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 30945) |
| 207X00000X Orthopaedic Surgery (Licence: MN 69880) | |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2025-08-04 |