| NPI | 1902965262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MD D35161) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: DC MD16795) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0101040980) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2021-02-16 |