| NPI | 1770108821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301512670) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4351046399) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2025-04-01 |