| NPI | 1457463655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WY 8173A) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OK 21200) |
| 207X00000X Orthopaedic Surgery (Licence: NE 22469) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2026-06-02 |