| NPI | 1386943777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MA 278065) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY TP814) |
| 207X00000X Orthopaedic Surgery (Licence: NE 26976) | |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2021-05-06 |