NPI | 1538629746 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101282145) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL 125.075115) |
207X00000X Orthopaedic Surgery (Licence: IL Pending) | |
Enumeration Date | 2019-03-22 |
Last Update Date | 2024-07-18 |