| NPI | 1700442159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 112232) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO DR75336) |
| 207X00000X Orthopaedic Surgery (Licence: FL OS17065) | |
| Enumeration Date | 2019-05-11 |
| Last Update Date | 2026-08-10 |