| NPI | 1306163779 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: AR E-10568)  | 
| Additional Taxonomies | 208600000X Surgery (Licence: AR 208600000X)  | 
| Enumeration Date | 2010-04-26 | 
| Last Update Date | 2021-12-03 |