| NPI | 1174613772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD442325) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: UT 290105-1205) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2020-08-10 |