| NPI | 1053670794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AL MD.36056) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL 17310) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2017-08-09 |