| NPI | 1376863456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2015-00253) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT013666) |
| 207X00000X Orthopaedic Surgery (Licence: TN 2806) | |
| 207X00000X Orthopaedic Surgery (Licence: PA OS017457) | |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2015-07-08 |