| NPI | 1700856101 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: LA 10329R) | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX E8504) | 
| Enumeration Date | 2006-01-26 | 
| Last Update Date | 2012-11-13 |