| NPI | 1881865459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA 131149) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VT 042-0012721) |
| 207X00000X Orthopaedic Surgery (Licence: NY 304506) | |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2020-06-18 |