NPI | 1972659183 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME133499) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.089154) |
Enumeration Date | 2007-01-28 |
Last Update Date | 2020-08-25 |