| NPI | 1881076198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2021014909) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 05-48109) |
| 207X00000X Orthopaedic Surgery (Licence: CA 20A18135) | |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2025-10-21 |