| NPI | 1609919364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MT 4815) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ND 5302) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2010-02-18 |