| NPI | 1871715078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO 49282) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60078261) |
| 207X00000X Orthopaedic Surgery (Licence: PA MT186161) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2021-02-25 |