| NPI | 1497002471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NV 20444) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WV 36953) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2026-08-26 |