| NPI | 1316982390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 52898-020) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2004026423) |
| 207X00000X Orthopaedic Surgery (Licence: FL ME102066) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2015-04-15 |