| NPI | 1093036964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY TP121) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101018825) |
| 207X00000X Orthopaedic Surgery (Licence: TN 2860) | |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2020-05-19 |