| NPI | 1972030716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL OS20447) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101023113) |
| 207X00000X Orthopaedic Surgery (Licence: NV DO3114) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2026-08-28 |