| NPI | 1760740096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: VA 0101266265) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 62116) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0101266265) | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2022-09-23 |