| NPI | 1659862555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 8101734-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT215025) |
| 207X00000X Orthopaedic Surgery (Licence: PA MD471072) | |
| 207X00000X Orthopaedic Surgery (Licence: NM MD2023-0551) | |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2025-01-29 |