| NPI | 1598127615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2022036718) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MS 28415) |
| 207X00000X Orthopaedic Surgery (Licence: KY R4193) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2022-09-20 |