| NPI | 1013971134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX F3042) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO DRP 0000604) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2017-04-26 |