| NPI | 1053304907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA OS004772L) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 34005999) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2012-06-08 |