| NPI | 1417997743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 49788) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI 09799) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2018-12-17 |