| NPI | 1144669912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A168852) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MT 73119) |
| 207X00000X Orthopaedic Surgery (Licence: IA R-9822) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2026-05-26 |