| NPI | 1457615866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2012020191) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OS018239) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2019-12-10 |