| NPI | 1154618858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2017026550) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 34012103) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2022-02-17 |