| NPI | 1356870638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A194037) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI MD18295) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2024-03-26 |