| NPI | 1013039759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MI 5101015359) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 9041) |
| 207X00000X Orthopaedic Surgery (Licence: WV 2233) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2016-08-03 |