| NPI | 1912291469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NE 29897) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 65100-20) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2017-08-01 |