| NPI | 1902994239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: DC MD18740) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD D40787) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0101046643) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2020-06-06 |