| NPI | 1689092520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NM MD2025-0477) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 04-40286) |
| 207X00000X Orthopaedic Surgery (Licence: MO 2017011921) | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2025-09-16 |