| NPI | 1871835876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2019024768) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 04-42361) |
| 207X00000X Orthopaedic Surgery (Licence: CT 60366) | |
| Enumeration Date | 2013-03-18 |
| Last Update Date | 2020-01-11 |