| NPI | 1083831887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: LA 012489) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA 12489) |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2023-02-20 |