| NPI | 1023631561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX W4901) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TN 74278) |
| 207X00000X Orthopaedic Surgery (Licence: SC 84541) | |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2026-08-26 |