| NPI | 1760829915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: CT 62967) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA L-255283) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2019-05-14 |