| NPI | 1205285483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2021-01235) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301109695) |
| 207X00000X Orthopaedic Surgery (Licence: ID M-16456) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2025-07-22 |