| NPI | 1376993162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: VA 0101274760) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT211917) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: IL 125.077272) | |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2022-10-05 |