| NPI | 1053316786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID M-13759) |
| Additional Taxonomies | 174400000X Specialist (Licence: OK 20183) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2018-12-28 |