| NPI | 1528098340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NE 6289) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 1096) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2015-08-16 |