| NPI | 1366524589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA OP00001667) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OR DO22080) |
| 207X00000X Orthopaedic Surgery (Licence: MI 5101011852) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2012-02-28 |