NPI | 1073856365 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 5601006443) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006443) |
Enumeration Date | 2013-04-04 |
Last Update Date | 2023-05-15 |