| NPI | 1629423223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NM DO2021-0038) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM R-03-2016MNT) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2023-09-01 |