| NPI | 1033473574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 10519756-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NV 16883) |
| 207X00000X Orthopaedic Surgery (Licence: MI 4301101608) | |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2021-04-15 |