| NPI | 1164419685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD 60287490) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301407172) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2012-11-05 |