| NPI | 1053730606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 11701072) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 71214) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2022-04-04 |