| NPI | 1184979684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 291151) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 01012549990) |
| 207X00000X Orthopaedic Surgery (Licence: PA MD467563) | |
| 207X00000X Orthopaedic Surgery (Licence: WV 30639) | |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2023-08-17 |