| NPI | 1740414317 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL OS13280)  | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL UO2075)  | 
| Enumeration Date | 2009-05-11 | 
| Last Update Date | 2020-10-05 |