| NPI | 1669792156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 53083) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 244573) |
| 207X00000X Orthopaedic Surgery (Licence: KY TP543) | |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2019-09-20 |