| NPI | 1790890895 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: DC 035982) | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: DC 035982) | 
| Enumeration Date | 2006-08-20 | 
| Last Update Date | 2025-10-01 |