| NPI | 1164983722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 77217) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 294016) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2025-08-13 |