| NPI | 1831852367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MO 2024037827) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO DR.0071180) |
| 207X00000X Orthopaedic Surgery (Licence: MD D0103596) | |
| 207X00000X Orthopaedic Surgery (Licence: DC MD600004073) | |
| 207X00000X Orthopaedic Surgery (Licence: MO 2024037827) | |
| Enumeration Date | 2021-10-21 |
| Last Update Date | 2025-09-19 |