| NPI | 1972730604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA OS017449) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL OS12496) |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2022-07-05 |