| NPI | 1780078790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: ID M-15711) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101268375) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2022-12-01 |