| NPI | 1104483239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT217509) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD488799) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2026-06-15 |