| NPI | 1801200340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX S5380) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OK 30812) |
| 207X00000X Orthopaedic Surgery (Licence: TX S5380) | |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2023-01-31 |