| NPI | 1457321796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CT 030404) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 030404) |
| 207X00000X Orthopaedic Surgery (Licence: CT 030404) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CT 030404) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2013-07-29 |