| NPI | 1174563092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: WV 14240) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WV 14240) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2022-04-05 |