| NPI | 1861693095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TN 2291) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WY TL1160) |
| Enumeration Date | 2007-05-28 |
| Last Update Date | 2025-09-30 |