| NPI | 1265583587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A119628) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO CDRH.0072101) |
| 207X00000X Orthopaedic Surgery (Licence: NE 23242) | |
| 207X00000X Orthopaedic Surgery (Licence: KY tp995) | |
| 207X00000X Orthopaedic Surgery (Licence: AZ 75147) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2025-08-05 |