| NPI | 1710416946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2023-02940) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TN 66195) |
| Enumeration Date | 2017-06-10 |
| Last Update Date | 2023-10-10 |