| NPI | 1902037468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL OS13567) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 272976) |
| 207X00000X Orthopaedic Surgery (Licence: WV 2884) | |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2020-01-31 |