| NPI | 1811494750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 15332) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 29300) |
| 207X00000X Orthopaedic Surgery (Licence: MN 65893) | |
| Enumeration Date | 2018-04-08 |
| Last Update Date | 2026-04-22 |