| NPI | 1205492949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX V6341) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI MD19991) |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2026-07-08 |