| NPI | 1770998627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 5101021063) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 34.013651) |
| Enumeration Date | 2014-06-29 |
| Last Update Date | 2021-04-06 |