| NPI | 1609007921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: DE C5-0000675) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD c0008000) |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2025-09-22 |