| NPI | 1659691210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID M-12861) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT196613) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2022-07-21 |