| NPI | 1487670634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MD H84961) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 34.012790) |
| 207X00000X Orthopaedic Surgery (Licence: PA OT014667) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2022-07-21 |