| NPI | 1245205020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 73625) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101232250) |
| 207X00000X Orthopaedic Surgery (Licence: KY 43365) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2019-11-19 |