| NPI | 1366641789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX P4440) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.099289) |
| 207X00000X Orthopaedic Surgery (Licence: WI 60790) | |
| 207X00000X Orthopaedic Surgery (Licence: IL 125-052536) | |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2021-12-09 |