| NPI | 1811193444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME121959) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA 322038) |
| 207X00000X Orthopaedic Surgery (Licence: HI MDR-5314) | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2020-09-09 |