| NPI | 1326012071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301087035) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 82020) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2016-06-06 |