| NPI | 1902260193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 55787) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY TP212) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2023-04-18 |