| NPI | 1184628570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 52367) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY 44911) |
| 207X00000X Orthopaedic Surgery (Licence: PA 042873-E) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2022-11-28 |