| NPI | 1083052633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 62495) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD463657) |
| 207X00000X Orthopaedic Surgery (Licence: MA L-255183) | |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2021-06-24 |