| NPI | 1033101290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: LA 014608) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MS 16725) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2008-06-17 |