| NPI | 1629063508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IA 36716) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 23828) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2012-07-13 |