| NPI | 1184807729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 47024) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: RI 13754) |
| 207X00000X Orthopaedic Surgery (Licence: RI 13754) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2016-11-03 |