| NPI | 1154305571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME68816) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 150718) |
| 207X00000X Orthopaedic Surgery (Licence: CA G148755) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2021-05-04 |