| NPI | 1124008818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: LA 11829R) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 11829R) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2011-10-05 |