| NPI | 1114456597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2023022673) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 94-09234) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2025-03-19 |