| NPI | 1508220187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 21069) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 62470) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2021-08-06 |