| NPI | 1508842154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ND 11139) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 46647) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2010-02-11 |