| NPI | 1417330036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: VA 0102206782) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT016520) |
| 207X00000X Orthopaedic Surgery (Licence: OH 34.014506) | |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: OH 34.014506) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2023-07-19 |