| NPI | 1962198531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0076179) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 60-P121003-01) |
| 207X00000X Orthopaedic Surgery (Licence: NM RS2024-0020) | |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2025-09-15 |