| NPI | 1457613259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 61888) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 268626) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2018-09-18 |