| NPI | 1235207721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL 125635) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 013639) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2017-01-31 |