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 |