| NPI | 1154841872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 3843) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101023487) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2022-05-23 |