| NPI | 1205220100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TN 74312) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME151610) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2025-07-31 |