| NPI | 1770024911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 95153) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD484552) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2025-07-22 |