| NPI | 1073700019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 44601) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME105941) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2012-06-21 |