| NPI | 1144460296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR DO187093) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0102202485) |
| 207X00000X Orthopaedic Surgery (Licence: OH 58-002720) | |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2021-01-20 |