| NPI | 1891149910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 87415) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 218276) |
| 207X00000X Orthopaedic Surgery (Licence: NC 2022-01012) | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2023-10-13 |