| NPI | 1720763907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2026033279) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AL L6192F) |
| Enumeration Date | 2023-06-16 |
| Last Update Date | 2026-07-24 |