| NPI | 1164611687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MA 251049) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 233439) |
| Enumeration Date | 2007-10-21 |
| Last Update Date | 2018-08-29 |