| NPI | 1801416110 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX V6124) | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL 125.076010) | 
| Enumeration Date | 2020-04-16 | 
| Last Update Date | 2025-10-28 |