| NPI | 1356440754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 61746) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 56273) |
| 207X00000X Orthopaedic Surgery (Licence: RI DO00392) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2018-10-15 |