| NPI | 1821114604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: CT 68636) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301102096) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2021-07-08 |