| NPI | 1700859170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 49448) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 48448) |
| 207X00000X Orthopaedic Surgery (Licence: CT 020356) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2009-03-02 |