| NPI | 1568845311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101269077) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 7602) |
| 207X00000X Orthopaedic Surgery (Licence: MN 69303) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2021-07-16 |