| NPI | 1912010901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 35768) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA md00045395) |
| 207X00000X Orthopaedic Surgery (Licence: UT 6769954-1205) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2023-03-10 |