| NPI | 1205395134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: TX V7496) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX V7496) |
| 207X00000X Orthopaedic Surgery (Licence: OH 35.150048) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-08-15 |