| NPI | 1174919054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 287699) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 263346) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2021-08-13 |