| NPI | 1225252604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 22134) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 230657) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2021-12-01 |