| NPI | 1053979039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY TP207) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IA R-11549) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2024-07-03 |