| NPI | 1003902354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ND 13036) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 24653) |
| 207X00000X Orthopaedic Surgery (Licence: FL 113618) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2018-04-27 |