| NPI | 1962467324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: UT 11609028-1205) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AZ 52485) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2026-03-24 |