| NPI | 1457733495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 75786) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301107364) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2021-12-17 |