| NPI | 1134514532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 58849) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2021-02615) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2025-07-30 |