| NPI | 1043573371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL OS14483) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101019993) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2018-06-06 |