| NPI | 1528506607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 34.015892) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0102207240) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2023-09-19 |