| NPI | 1700986122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 40158) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 40158) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2009-02-04 |