| NPI | 1386618916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 55529) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 46129) |
| 207X00000X Orthopaedic Surgery (Licence: IA 39653) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2015-04-14 |