| NPI | 1912027608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 8295) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 49820) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2026-04-21 |