| NPI | 1912565763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MS 35263) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL 166939) |
| 207X00000X Orthopaedic Surgery (Licence: SC LL82680) | |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2025-08-18 |