| NPI | 1285193375 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 76868) | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM MD2024-0234) | 
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: NM MD2024-0234) | |
| Enumeration Date | 2019-03-18 | 
| Last Update Date | 2025-08-18 |