| NPI | 1942628300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 11641008-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301116837) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2026-08-13 |