| NPI | 1104884964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 30285) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101256466) |
| 207X00000X Orthopaedic Surgery (Licence: SC 39118) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2018-05-29 |