| NPI | 1417950569 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IA 215501) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 24542) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2015-01-22 |