| NPI | 1700878147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2010002299) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OS005811L) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2013-09-23 |