| NPI | 1780694588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 28851) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL28851) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2021-03-15 |