| NPI | 1740772417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 82012) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IA R-11174) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2023-08-25 |