| NPI | 1386191682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 15502) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IA DO-05701) |
| 207X00000X Orthopaedic Surgery (Licence: NE 2942) | |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2025-07-02 |