| NPI | 1265095319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374700000X Technician |
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: CO 95214) |
| 208600000X Surgery (Licence: CO 95214) | |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2019-04-15 |