| NPI | 1477111342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 20200019049) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 279551) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2020-07-10 |