| NPI | 1568497402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60134839) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.084942) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2011-10-12 |