| NPI | 1518939974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ND 3782) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 31925) |
| 207X00000X Orthopaedic Surgery (Licence: SD 5131) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2010-04-28 |