| NPI | 1548219702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R122529) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD R122529) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2007-11-21 |