| NPI | 1457396186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MT 8370) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MT MED-PHYS-LIC-8370) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2025-12-18 |