| NPI | 1598077489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 5101021842) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OS016097) |
| 207X00000X Orthopaedic Surgery (Licence: WV 2905) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2021-02-03 |