| NPI | 1033110309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA OP00002156) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI WT009964) |
| 207X00000X Orthopaedic Surgery (Licence: PA OS008481L) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2010-11-19 |