| NPI | 1952964868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: RI MD20121) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ND 22254) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2026-04-16 |