| NPI | 1750657904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 69496) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD461164) |
| Enumeration Date | 2012-03-31 |
| Last Update Date | 2019-11-09 |