| NPI | 1134295165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 67281) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 003151) |
| 207X00000X Orthopaedic Surgery (Licence: NC 2011-00402) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2015-09-01 |