| NPI | 1902804198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TN MD42863) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MS 16020) |
| 207X00000X Orthopaedic Surgery (Licence: KY 55872) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2021-12-08 |