| NPI | 1346653714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO 0062022) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SC LL36940) |
| 207X00000X Orthopaedic Surgery (Licence: GA 84658) | |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2020-04-16 |