| NPI | 1902467129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WY 18685A) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TN 0000070291) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2025-08-07 |