| NPI | 1952907008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: HI AMD-1049) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: HI LKJ) |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2021-11-17 |