| NPI | 1073807335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 61383) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 249123) |
| Enumeration Date | 2011-06-04 |
| Last Update Date | 2021-06-28 |