| NPI | 1891224390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MA 1014724) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NH 24058) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2026-01-23 |