| 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 |