| NPI | 1730482167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NV DO2109) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WY 9494A) |
| 207X00000X Orthopaedic Surgery (Licence: MI 5101017901) | |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2016-09-16 |