| NPI | 1336124890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 5101010937) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WY 7949A) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2026-03-10 |