| NPI | 1215980420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO 39283) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IA MD-45982) |
| 207X00000X Orthopaedic Surgery (Licence: SD 11200) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2020-09-25 |