| NPI | 1346668480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 75312) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 282380) |
| 207XX0801X Orthopaedic Surgery Orthopaedic Trauma (Licence: MA 282380) | |
| Enumeration Date | 2014-04-05 |
| Last Update Date | 2021-09-13 |