| NPI | 1043503279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: OH 130629) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 274224) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2024-06-02 |