| NPI | 1104266444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID O-1246) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 1.061149-RES) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2023-01-27 |