| NPI | 1265827612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 287016) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD D89106) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2026-04-10 |