| NPI | 1821357773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 51146) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 269727) |
| Enumeration Date | 2012-05-13 |
| Last Update Date | 2022-05-02 |