| NPI | 1710347588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD479004) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101263392) |
| 207X00000X Orthopaedic Surgery (Licence: RI MD20651) | |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2026-08-28 |