| NPI | 1215912654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 226811) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 9800903) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2012-10-16 |