| NPI | 1780790824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101043904) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD D74645) |
| 207X00000X Orthopaedic Surgery (Licence: NC 2015-02063) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2021-10-12 |