| NPI | 1518024488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WY 9748A) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 478) |
| 207X00000X Orthopaedic Surgery (Licence: NC 2013-01139) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2014-09-15 |