| NPI | 1841566049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MT 66727) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA 60294633) |
| 207X00000X Orthopaedic Surgery (Licence: NM MD2017-0260) | |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2022-07-21 |