| NPI | 1083603047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WY 6422A) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WY 4931310001) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2010-08-03 |