| NPI | 1972943488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 83726) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2013021778) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2021-01-22 |