| NPI | 1578091088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 56957) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IA R-10863) |
| Enumeration Date | 2017-05-28 |
| Last Update Date | 2022-07-21 |