| NPI | 1093102170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: OH 35.145365) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2021-02483) |
| 207X00000X Orthopaedic Surgery (Licence: FL ME145035) | |
| 207X00000X Orthopaedic Surgery (Licence: OH 35.145365) | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2022-08-25 |