| NPI | 1093709404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: WY 3152A) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NV 11130) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2020-06-03 |