| NPI | 1245223569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NM MD2006-0496) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA 15158R) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2011-12-27 |