| NPI | 1003033119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: RI MD13206) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM 2012-0546) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2019-02-14 |