| NPI | 1871056093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IA DO-06851) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OS023896) |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2026-07-20 |