| NPI | 1669613907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NH 16277) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 106300) |
| 207X00000X Orthopaedic Surgery (Licence: MN 55660) | |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2019-02-12 |