| NPI | 1225611890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101289194) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0116035487) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2026-06-17 |