| NPI | 1417482167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NC 2025-01701) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 100276) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2025-07-17 |