| NPI | 1861638199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2008017228) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-02451) |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2026-04-02 |