| NPI | 1114242005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR MD162188) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD162188) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: OR MD162188) | |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2022-05-14 |