| NPI | 1790762615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX L6057) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX L6057) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2025-02-25 |