| NPI | 1770016008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 82182-20) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL MD154952) |
| 207X00000X Orthopaedic Surgery (Licence: FL ME154952) | |
| 207X00000X Orthopaedic Surgery (Licence: IL 036-165184) | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2025-08-20 |