| NPI | 1902225766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2022030421) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SC 82172) |
| 207X00000X Orthopaedic Surgery (Licence: AR E-13197) | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2023-10-05 |