| NPI | 1639120504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 014608) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 014608) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2007-07-08 |