| NPI | 1568699841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101258423) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2014-00777) |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2019-08-14 |