| NPI | 1124463088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL OS15986) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OTO15084) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2025-07-28 |