| NPI | 1174052682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 75696) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI MD18379) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2023-08-11 |