| NPI | 1568690915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 48118) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WV 24563) |
| 207X00000X Orthopaedic Surgery (Licence: GA 71324) | |
| 207X00000X Orthopaedic Surgery (Licence: AL 33299) | |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2021-11-17 |