| NPI | 1649469628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A118845) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57013123) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2013-11-08 |