| NPI | 1194085514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NE 31122) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 269954) |
| 207X00000X Orthopaedic Surgery (Licence: IA MD-45594) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2020-12-31 |