| NPI | 1366560179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX G7206) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA 013130) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2007-07-11 |