| NPI | 1164861449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NE 2065) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101020408) |
| 207X00000X Orthopaedic Surgery (Licence: AZ 007523) | |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2019-08-13 |