| NPI | 1376541615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 22661) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101035655) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2015-12-14 |