| NPI | 1659348308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 24473) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 25714) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2007-10-31 |