| NPI | 1053607408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 68045) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL 125060032) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2020-09-14 |