| NPI | 1053305672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID M-9364) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MT 10341) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2012-01-18 |