| NPI | 1235764176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 96519) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101274747) |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2026-08-31 |