| NPI | 1972006211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: MA 1022090) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 1022090) |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2025-04-30 |