| NPI | 1588169700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KS 04-48882) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2024004349) |
| 207X00000X Orthopaedic Surgery (Licence: NY 321898-01) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2024-04-26 |