| NPI | 1417318171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID Pending) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101022655) |
| 207X00000X Orthopaedic Surgery (Licence: OH 58.030544) | |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2022-05-16 |