| NPI | 1134138753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2018-00178) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 47899-020) |
| 208600000X Surgery (Licence: NC 86175) | |
| 208600000X Surgery (Licence: WI 47899) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2022-05-13 |