| NPI | 1104054311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 58654) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A131563) |
| 207X00000X Orthopaedic Surgery (Licence: GA 073874) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2019-08-26 |