| NPI | 1790706505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AR C-7011) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SD 7623) |
| 207X00000X Orthopaedic Surgery (Licence: MO 100174) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2021-02-23 |