| NPI | 1174813554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 56169) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: UT 9742281-1205) |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2021-06-24 |