| NPI | 1093196180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 77010) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 077010) |
| 207X00000X Orthopaedic Surgery (Licence: KY 56057) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2025-02-11 |