| NPI | 1003979105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR MD167415) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 42996) |
| 207X00000X Orthopaedic Surgery (Licence: WY 4069A) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2016-02-17 |