| NPI | 1396857108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WY 9013A) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML20008721) |
| 207X00000X Orthopaedic Surgery (Licence: NM MD2011-0201) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-08-22 |