| NPI | 1679077531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 59704) |
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery Orthopaedic Trauma (Licence: KY 59704) |
| 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: KY 59704) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2024-10-07 |