| NPI | 1588016182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX 2471) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PR 21896) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2022-03-29 |