| NPI | 1962601062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 2940) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OS013014) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2020-05-22 |