| NPI | 1164878237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: MO 2022011296) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OK 32382) |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2022-08-30 |