| NPI | 1205191285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301117513) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2012020349) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2019-08-02 |