| NPI | 1124409453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101272265) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2020-00438) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2022-08-08 |