| NPI | 1184986267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 71031) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT201601) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2023-03-28 |