| NPI | 1629179247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WY 2769A) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WY 0518540001) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2008-01-09 |