| NPI | 1982139812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 81970) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 0000000) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2023-08-22 |