| NPI | 1770965899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2021-02373) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101021890) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2022-10-18 |