| NPI | 1255393666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VT 0420010897) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 150470) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2010-06-09 |