| NPI | 1558696757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 9312457-1204) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101018437) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0102203745) | |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2021-09-29 |