| NPI | 1487604542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35070366) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI JM051623) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2016-09-12 |