| NPI | 1093960023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 256827) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 104274) |
| 207X00000X Orthopaedic Surgery (Licence: MN 52198) | |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2012-02-16 |