| NPI | 1811212236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX T6313) |
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery Orthopaedic Trauma (Licence: MI 4301109445) |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2022-07-13 |