| NPI | 1558655308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA OS017763) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO OT014295) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2022-07-21 |