| NPI | 1548469315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR DO150596) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101016458) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2010-08-10 |