| NPI | 1568992527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301602180) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD478235) |
| 207X00000X Orthopaedic Surgery (Licence: MI 4301112406) | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2022-11-14 |