| NPI | 1356552657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO 51478) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 57012209) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2012-07-26 |