| NPI | 1972958437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NC 2022-01510) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 217913) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MA 286535) | |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2023-01-18 |