| NPI | 1467238360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 13341) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-13617) |
| Enumeration Date | 2023-09-06 |
| Last Update Date | 2025-11-17 |