| NPI | 1942822374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA OT020025) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 82125-21) |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2026-07-07 |