| NPI | 1184619314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 40622) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 050892) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2017-05-25 |