| NPI | 1154392983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 26776) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TN MD0000031796) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2022-04-06 |