| NPI | 1568769941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ND 13517) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OS015601) |
| 207X00000X Orthopaedic Surgery (Licence: OH 34.010061) | |
| Enumeration Date | 2011-02-19 |
| Last Update Date | 2020-06-08 |