| NPI | 1316473424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2023-00638) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101023005) |
| 207X00000X Orthopaedic Surgery (Licence: PA OS022280) | |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2023-06-06 |