| NPI | 1205809407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA OS006155L) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS006155L) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2018-02-16 |