| NPI | 1831453158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MS T-2600) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MS 25801) |
| 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: UT 10277685-1205) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2020-07-21 |