| NPI | 1124644828 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 104746) | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IA R-11990) | 
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: GA 104746) | |
| Enumeration Date | 2020-06-19 | 
| Last Update Date | 2025-06-20 |