| NPI | 1902841406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME75825) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME75825) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2025-06-03 |