| NPI | 1962718874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 85705) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD 390200000x) |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2022-02-09 |