| NPI | 1396700902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: SC MD37707) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 29370) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2021-01-29 |