| NPI | 1710050521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PR 16682) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16682) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2008-08-07 |