| NPI | 1174816052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60758083) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OR MD183695) |
| 207X00000X Orthopaedic Surgery (Licence: MI 4301098276) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2026-06-30 |