| NPI | 1114948122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TN MD15735) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 051388) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2008-03-03 |