| NPI | 1750584355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA C154842) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NV 13003) |
| 207X00000X Orthopaedic Surgery (Licence: TX L6419) | |
| 207X00000X Orthopaedic Surgery (Licence: ND 14934) | |
| Enumeration Date | 2007-06-09 |
| Last Update Date | 2026-06-08 |