| NPI | 1659652451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV MSF1006) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY 47314) |
| 207X00000X Orthopaedic Surgery (Licence: AL L.3447R) | |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2021-11-17 |