| NPI | 1679100358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301517600) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 1022024) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2026-06-22 |