| NPI | 1063617561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 83769) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2020-00449) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2023-10-19 |