| NPI | 1003805359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101840374) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2019-02642) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2024-06-21 |