| NPI | 1508069618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MI 4301089873) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 264801) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2014-01-09 |