| NPI | 1902101702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 75166) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SC 33535) |
| 207X00000X Orthopaedic Surgery (Licence: AL MD.34858) | |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2020-11-20 |