| NPI | 1578572129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MT 12306) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 104281) |
| 207X00000X Orthopaedic Surgery (Licence: MN 52250) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2012-01-30 |