| NPI | 1164049805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101289203) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4351046415) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2026-07-24 |