| NPI | 1154328029 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IA 27856) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 36319) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2010-07-14 |