| NPI | 1023306859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2015015073) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT014391) |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2021-03-01 |