| NPI | 1720609068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME172033) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ R78061) |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2025-07-28 |