| NPI | 1356558464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: WI 51760) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 58000956) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2015-03-18 |