| NPI | 1689369449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MT231018) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4351051284) |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2024-06-10 |