| NPI | 1932513058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO 61701) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA L-260559) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2022-03-18 |