| NPI | 1043760754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 5151016552) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007913) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2024-05-18 |