| NPI | 1780212415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NH 39821) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 1022898) |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2026-09-26 |