| NPI | 1902473713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 79098) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 94-10497) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2026-04-07 |