| NPI | 1578552063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NE 17324) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 17324) |
| 207X00000X Orthopaedic Surgery (Licence: IA 27983) | |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2022-06-23 |