| NPI | 1508214669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2025020901) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL 125.068544) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2025-07-08 |