| NPI | 1679070544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301512076) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2023-01808) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2025-09-24 |