| NPI | 1790170769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NM A-2469-21) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101021715) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2024-03-20 |