| NPI | 1457579435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME99816) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AL 12345678) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2017-01-18 |