| NPI | 1811257561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 52644) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY R3102) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2021-09-03 |