| NPI | 1164602868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX N6757) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX N6757) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2025-09-04 |