| NPI | 1205364296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2023-00626) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IA R-10973) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2025-04-18 |