| NPI | 1992283709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MN 81931) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 13198) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: WI 87311-20) | |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2026-06-11 |