| NPI | 1801209069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY TP397) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301105739) |
| 208D00000X General Practice (Licence: MI 4301105739) | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2022-07-21 |