| NPI | 1033162201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 38451) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 38451) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2011-10-19 |