| NPI | 1700833415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 48974) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2005028545) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2016-08-16 |