| NPI | 1205811130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 22872) |
| Additional Taxonomies | 174400000X Specialist (Licence: WV 22872) |
| 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: WV 22872) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2020-06-23 |