| NPI | 1790888691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO 36792) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD048555L) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2022-01-27 |