| NPI | 1679829352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301113951) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY 49750) |
| 207X00000X Orthopaedic Surgery (Licence: PA MT201489) | |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2018-09-11 |