| NPI | 1528220753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 3093355-1204) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101017892) |
| Enumeration Date | 2008-06-29 |
| Last Update Date | 2018-03-17 |