| NPI | 1053793208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 75716) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL 125066593) |
| 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: UT 11729390-1205) | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2021-12-14 |