| NPI | 1104054832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 8992398-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301094918) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2016-09-02 |