| NPI | 1104440049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX V7233) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL 125.076082) |
| Enumeration Date | 2020-06-06 |
| Last Update Date | 2025-06-18 |