| NPI | 1790952406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AR E10619) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 57-013137) |
| 207X00000X Orthopaedic Surgery (Licence: VA 01011251395) | |
| 207X00000X Orthopaedic Surgery (Licence: WY 9348A) | |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2018-06-16 |