| NPI | 1427317056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: VA 0102207097) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AK 135655) |
| 207X00000X Orthopaedic Surgery (Licence: MI 5101019727) | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2022-07-26 |