NPI | 1154701670 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.142413) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 264108) |
Enumeration Date | 2015-06-01 |
Last Update Date | 2021-08-26 |