| NPI | 1063892560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NY 310012) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OK 5931) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NV DO2666) | |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2023-12-07 |