| NPI | 1124188776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2010-00751) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT185923) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0101258973) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2016-01-12 |