| NPI | 1104272574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IA DO-07088) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0102207700) |
| 207X00000X Orthopaedic Surgery (Licence: WA OP61112868) | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2026-01-28 |