| NPI | 1902124084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MT 44892) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT197246) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2023-11-27 |