| NPI | 1902487259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FM 72125) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 31632) |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2022-08-25 |