| NPI | 1992000582 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: WI 65503-20) | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301097026) | 
| Enumeration Date | 2011-01-13 | 
| Last Update Date | 2023-06-21 |