| NPI | 1215194105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 046482) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 243493) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2011-06-27 |