| NPI | 1609877463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301500979) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD042946L) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2025-03-17 |