| NPI | 1114979655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ND 5344) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 30240) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2014-02-05 |