| NPI | 1417023136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NM A586) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM A-586-71) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2011-04-15 |