| NPI | 1982267274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101285954) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 1018532) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2025-08-13 |