| NPI | 1144629205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL OS14887) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OS020026) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2026-09-15 |