| NPI | 1114306040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 89867) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 61045) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2021-08-31 |