| NPI | 1265008148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2026002933) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4351048484) |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2026-06-11 |