| NPI | 1104819747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: MO 35896) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 35896) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2012-04-19 |