| NPI | 1295113561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2021024886) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY 04758) |
| 207X00000X Orthopaedic Surgery (Licence: KS 05-45646) | |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2026-04-02 |