| NPI | 1457975187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 60482) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 94-10304) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2025-06-09 |