| NPI | 1649234642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX M5578) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD420540) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2015-01-06 |