| NPI | 1164981411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A181879) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A181879) |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2026-07-31 |