| NPI | 1811514805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2026042875) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT020414) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2026-10-12 |