| NPI | 1124089644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 51109) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SC 27179) |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: NC 200601748) | |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: NC 2006-01748) | |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: NC 2006-01748) | |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2026-05-19 |