| NPI | 1124013339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 36708) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 36708) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2008-03-04 |