| NPI | 1639123045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101039512) |
| Additional Taxonomies | 174400000X Specialist (Licence: HI MD-4154) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2023-01-23 |