| NPI | 1174662167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR MD28644) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM 2003-0224) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-10-13 |