| NPI | 1265873418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IA 47530) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 276388) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MI 4301103884) | |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2021-02-15 |