| NPI | 1962963926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IA MD-55714) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IA MD-55714) |
| 207X00000X Orthopaedic Surgery (Licence: PA MT232833) | |
| Enumeration Date | 2019-03-30 |
| Last Update Date | 2025-10-17 |