| NPI | 1790074888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 57583) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 60169) |
| 207X00000X Orthopaedic Surgery (Licence: WI 57583-20) | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2022-07-21 |