| NPI | 1548364987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR MD10388) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD00035112) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2007-07-13 |