| NPI | 1245762996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 91716) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY R4563) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2022-10-03 |