| NPI | 1639515984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: LA 320551) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA L-255690) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2021-06-21 |