| NPI | 1518205822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NM MD2022-0003) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 081167) |
| 207X00000X Orthopaedic Surgery (Licence: WA MD60913021) | |
| Enumeration Date | 2013-01-21 |
| Last Update Date | 2022-07-01 |