| NPI | 1023017555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX D9381) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NH 14488) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2009-11-04 |