| NPI | 1679567192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101234728) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD439714) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2012-07-27 |