| NPI | 1972592772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 25891) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 36728) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2023-03-30 |