| NPI | 1104998715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 2597) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0102203336) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2022-09-02 |