| NPI | 1487917068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 71257) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2025-01292) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2025-05-07 |