| NPI | 1619236254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 5101019741) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 270630) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2023-04-10 |