| NPI | 1629283148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA OP60222153) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101016506) |
| 207X00000X Orthopaedic Surgery (Licence: OR DO151061) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2013-02-04 |