| NPI | 1104232255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO DR.0076497) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2021031343) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2026-04-29 |