| NPI | 1639794811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX V6047) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 11997) |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2026-03-19 |