| NPI | 1508480013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2025-00899) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4351046002) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2025-07-29 |