| NPI | 1134187008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WY 6015A) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA G71812) |
| 207X00000X Orthopaedic Surgery (Licence: MA 71396) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2022-07-29 |