| NPI | 1104184092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 61103) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 61103-20) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2020-09-14 |