| NPI | 1174745640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 42502) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A99828) |
| 207X00000X Orthopaedic Surgery (Licence: NC 2008-00292) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2014-05-19 |