| NPI | 1942400544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 54694) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT010925) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2022-05-25 |