| NPI | 1487628889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 264926) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD039461E) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2017-08-29 |