| NPI | 1164942413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 81170-21) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT017570) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2023-08-02 |