| NPI | 1730372764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 53589) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NV 13106) |
| 207X00000X Orthopaedic Surgery (Licence: CA A106727) | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2021-12-28 |