| NPI | 1245526730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 27761) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2011018414) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2021-01-09 |