| NPI | 1154701670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NM MD2024-0466) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 264108) |
| 207X00000X Orthopaedic Surgery (Licence: OH 35.142413) | |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2024-06-07 |