| NPI | 1780033928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 75714) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301110098) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2022-10-19 |