| NPI | 1083618615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 007480) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101012747) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2022-04-11 |