| NPI | 1740575851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ND 14609) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301098639) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2022-07-21 |