| NPI | 1407085103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: IA DO-04737) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101018316) |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2015-08-07 |