| NPI | 1568649812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 34221) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2013-00002) |
| 207X00000X Orthopaedic Surgery (Licence: MT 21200) | |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2019-10-28 |