| NPI | 1982165791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD490425) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A194915) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2025-09-24 |